Jump for Joy… Without Leaking

WRITTEN BY ALAINA TOWN BENNETT, MD, MS, FACOG - BOZEMAN HEALTH

This is a common phrase I hear from patients. As a urogynecologist, I specialize in caring for women with pelvic floor disorders. This includes leaking urine with activities such as running, sneezing or laughing. This leakage is called stress urinary incontinence (SUI). Approximately one in four women have SUI symptoms. SUI can be severely disruptive and, while many women think SUI is normal and they just have to “live with it,” it is typically very treatable.

Why SUI Happens

SUI can result from the long-term impacts of forces on the pelvic floor such as age, pregnancy and childbirth, excess body weight or chronic coughing. Jumping and laughing are some activities that increase abdominal pressure. The muscles that reflexively contract when abdominal pressure increases are supposed to squish the urethra onto the firm connective tissue beneath it, pinching off the flow of urine (like stepping on a hose on your driveway). SUI occurs when the urethra doesn’t close enough during these increased pressure events and the urine can spurt out from the bladder. This is usually due to inadequate support underneath the urethra, like the driveway is missing. Instead of getting pinched, the urethra just moves down and doesn’t close. This is called “urethral hypermobility.”

What You Can Do About It

For some women, SUI symptoms may not be troublesome, but may still be improved using simple strategies. Menstrual pads or panty liners can reduce mild SUI impact. There is also underwear specifically designed to catch small amounts of urine. There are a variety of these washable, eco-conscious and sometimes even stylish undies on the market.

For many women with moderate to severe SUI, reducing or eliminating the leakage can greatly restore quality of life. There are many safe and effective treatments for SUI, starting with pelvic floor muscle exercise (PFME) known by many as “Kegels.” PFME is retraining the muscles deep inside the pelvis that control urine and gas.

Doing 10 reps of PFME three to 10 times per day strengthens the muscles around the bladder, vagina and rectum, and can greatly improve or eliminate SUI. Unfortunately, using the correct muscles can sometimes be difficult. A trained pelvic floor physical therapist (thankfully, we have many in Montana including at Bozeman Health) can use non-invasive ultrasound and biofeedback to help women learn to target the right muscles during PFME. For those who don’t have access to pelvic floor physical therapy, a pelvic floor muscle trainer or emerging MRI technology may be a good option. Whether rehabbing at home or with a practitioner, strengthening the pelvic floor is often very helpful for women with SUI.

Pessaries are another non-surgical option for treatment of SUI. I like to think of pessaries as sports bras for the bladder. These are essentially reusable silicone tampons shaped to provide support under the urethra. They are available over the counter or from many gynecologists’ offices and are particularly helpful for women who only have SUI in certain situations, such as during exercise.

We now perform several safe and effective procedures to correct SUI. In the last five years, data has really grown supporting the use of more minimally invasive procedures that get women back to activity faster, such as urethral bulking and single-incision slings. Well established procedures such as mid-urethral slings, fascial slings and colposuspension can also restore quality of life for many women. For women affected by SUI, there has never been a better time to explore their surgical choices with a trained physician.

“Jump for Joy”

I am incredibly grateful to care for women with SUI. I once received a message from a patient after a pessary fitting, that said she had cried with happiness when she was able to jump on the trampoline with her kids for the first time without leaking. It’s an honor to help women “jump for joy” after addressing SUI!

Dr. Bennett is a urogynecologist at Bozeman Health and a Montana parent of three young children. She is double board certified in Obstetrics & Gynecology and in Urogynecology and Reconstructive Pelvic Surgery by the American Board of Obstetrics & Gynecology, and her scientific research has been published in multiple peer-reviewed journals. Dr. Bennett is the first female urogynecologist in the state of Montana.